Résultats de recherche - Portail des modèles médicaux de données (portail MDM)

Brain and Central Nervous System Tumors NCT00978458 On-Study - E3F05 Neurologic Function Status and KPS Form - 2901661v1.0 - E3F05 Neurologic Function Status and KPS Form

- 08/01/2015 - 1 Formulaire, 7 Groupes Item, 22 Eléments de données, 1 Langue

Groupes Item: Header Module, ON TREATMENT, OFF TREATMENT, Amendment, Vital Status, Patient Characteristics, Footer Module

E3F05 Neurologic Function Status and KPS Form Radiation Therapy With or Without Temozolomide in Treating Patients With Low-Grade Glioma Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=6C76FF0A-A486-4EDB-E040-BB89AD4325FA

E3F05 Brain On-Study Form NCT00978458

- 16/06/2015 - 1 Formulaire, 8 Groupes Item, 43 Eléments de données, 1 Langue

Groupes Item: Header Module, Patient demographics, Data amendment, Patient Description Pre-Registration Hematology/Chemistry, Prior Brain Surgery, Motivation for Study Entry, Adverse Events present at time of registration (pre-treatment), Comments

E3F05 Brain On-Study Form NCT00978458 Radiation Therapy With or Without Temozolomide in Treating Patients With Low-Grade Glioma Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=6C76FF0A-A556-4EDB-E040-BB89AD4325FA

Pathology Reporting Form - Brain Tumor N0577

- 20/09/2021 - 1 Formulaire, 4 Groupes Item, 34 Eléments de données, 1 Langue

Groupes Item: Header, I. CRA/RN, II. Completed by the NCCTG Pathology reviewer, Comments and Pathology Reporting

North Central Cancer Treatment Group N0577 Pathology Reporting Form - Brain Tumor Radiation Therapy or Radiation Therapy and Temozolomide or Temozolomide Alone in Treating Patients With Newly Diagnosed Anaplastic Glioma Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=4CA85A1E-6D87-49C3-E044-0003BA3F9857

ACNS0122 Institutional Neuropathology Worksheet NCT00047320

- 21/06/2015 - 1 Formulaire, 4 Groupes Item, 15 Eléments de données, 1 Langue

Groupes Item: Header, Neuropathology, Comments, CCRR MODULE

ACNS0122 Institutional Neuropathology Worksheet NCT00047320 Neoadjuvant Chemotherapy With or Without Second-Look Surgery Followed by Radiation Therapy With or Without Peripheral Stem Cell Transplantation in Treating Patients With Intracranial Germ Cell Tumors Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=BD40C955-FB29-0C2A-E034-0003BA12F5E7

Neurocognitive Evaluation Summary Form (RTOG 0834)

- 09/01/2015 - 1 Formulaire, 5 Groupes Item, 36 Eléments de données, 1 Langue

Groupes Item: Header, Hopkins Verbal Learning Test - Revised Administration, Trail Making Test Part A, Trail Making Test Part B, Contolled Oral Word Association (COWA)

RTOG 0834/EORTC 26053_22054/NCIC CTG CEC.1: Neurocognitive Evaluation Summary Form Radiation Therapy With or Without Temozolomide in Treating Patients With Anaplastic Glioma Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=5A667C59-2D09-6D69-E044-0003BA3F9857

ACNS0122 Neurologic Assessment Worksheet NCT00047320

- 08/01/2016 - 1 Formulaire, 6 Groupes Item, 25 Eléments de données, 1 Langue

Groupes Item: Header, Neurologic Assessment, MENTAL STATUS, CRANIAL NERVES, MOTOR, Comments

ACNS0122 Neurologic Assessment Worksheet NCT00047320 Neoadjuvant Chemotherapy With or Without Second-Look Surgery Followed by Radiation Therapy With or Without Peripheral Stem Cell Transplantation in Treating Patients With Intracranial Germ Cell Tumors Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=BE457FF2-45E3-1E0F-E034-0003BA12F5E7

GBM Neurocognitive Evaluation Summary Form (CS) RTOG 0825 Phase III

- 09/01/2015 - 1 Formulaire, 6 Groupes Item, 39 Eléments de données, 1 Langue

Groupes Item: Header Module, Hopkins Verbal Learning Test - Revised Administration, Trail Making Test Part A, Trail Making Test Part B, Contolled Oral Word Association (COWA), Footer

RTOG 0825 Phase III GBM Neurocognitive Evaluation Summary Form (CS) Temozolomide and Radiation Therapy With or Without Bevacizumab in Treating Patients With Newly Diagnosed Glioblastoma Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=5BE60D36-11E5-00FF-E044-0003BA3F9857

Brain and Central Nervous System Tumors NCT00978458 Follow-Up - E3F05 Primary Brain Tumor Follow-Up Disease Evaluation Form - 2902962v1.0 - E3F05 Primary Brain Tumor Follow-Up Disease Evaluation Form

- 08/01/2015 - 1 Formulaire, 16 Groupes Item, 94 Eléments de données, 1 Langue

Groupes Item: Header Module, Header, ON TREATMENT, OFF TREATMENT, Section I, Section II MEASURABLE LESIONS, T2/FLAIR, T1/Contrast, Section III - Lesions Reported as Non-Measurable at Baseline, T2/FLAIR , T1/Contrast, Section IV New CNS Lesions/New Enhancement of Previously Reported Lesions, T2/FLAIR, T1/Contrast, Section V Progression, Comments

E3F05 Primary Brain Tumor Follow-Up Disease Evaluation Form Radiation Therapy With or Without Temozolomide in Treating Patients With Low-Grade Glioma Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=6CB91C46-8BDC-9A0D-E040-BB89AD433170

Registration Brain and Central Nervous System Tumors COG ADVL0912 NCT00939770

- 24/09/2015 - 1 Formulaire, 6 Groupes Item, 61 Eléments de données, 1 Langue

Groupes Item: Stratification, Inclusion Criteria, Organ Function - Hematological, Organ Function - Non Hematological, Exclusion Criteria, Consents

COG ADVL0912 OPEN Registration Worksheet NCT00939770 Crizotinib in Treating Young Patients With Relapsed or Refractory Solid Tumors or Anaplastic Large Cell Lymphoma Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A54DD196-B288-B398-E040-BB89AD432E23

E3F05 Baseline Primary Brain Tumor Disease Evaluation Form NCT00978458

- 16/06/2015 - 1 Formulaire, 10 Groupes Item, 38 Eléments de données, 1 Langue

Groupes Item: Header Module, Data amendment, Section I MEASURABLE LESIONS, T2/FLAIR, T1/Contrast, Section II NON-MEASURABLE LESIONS, T2/FLAIR Non-Measurable Lesions, T1/Contrast Non-Measurable Lesions, Section III, Comments

E3F05 Baseline Primary Brain Tumor Disease Evaluation Form NCT00978458 Radiation Therapy With or Without Temozolomide in Treating Patients With Low-Grade Glioma Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=6C1947D6-6AFF-2C82-E040-BB89AD4371C6